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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 7201
Experience:  Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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My son had a concussion almost 4 weeks ago. He stayed home

Customer Question

My son had a concussion almost 4 weeks ago. He stayed home for two weeks resting from TV, activities,etc. He was dizzy for most of the first wk and with headaches. In the hospital, they sent him home with rest instructions and to see pediatrician, but didn't do any scans. He has gone back to school (8th gr.) and headaches come and go in less frequency and intensite. But he still feels unsure going up steps and running. Is this normal? Should I take him for a test to a neurologist? The pediatrician does not think is necesary. He has forgotten a couple of conversations over the course of this period but nothing else. He even took a whole week of standarize tests at school. He still have an issue with his eyes if he looks at 3D postcards (we were at a store last Sunday).
Submitted: 1 year ago.
Category: Neurology
Expert:  Dr. Frank replied 1 year ago.

neuromd2012 :

Hello

neuromd2012 :

welcome to Just Answer

neuromd2012 :

I am a neurologist and am online to answer your questions

neuromd2012 :

I will start to write as you are offline, please review this and get back to me when you come online

neuromd2012 :

so one question would be about the concussion, what happened? how much velocity in impact?

neuromd2012 :

was there a loss of conciousness? or change in level of conciousness? for how long

neuromd2012 :

nausea/vomiting after as well? photophobia or light bothering his eyes after?

Customer:

Hi Dr. Duncan was playing basketball and was pushed from behind and hit the padded wall on top of his head.

Customer:

He didn't lose conciousness or vomited.

neuromd2012 :

hi

neuromd2012 :

ok

neuromd2012 :

so no major impact

neuromd2012 :

and that is why no imaging

Customer:

The sunlight does bother him when it's really bright outside

Customer:

Ok

neuromd2012 :

well that suggests meningeal irritation

neuromd2012 :

that comes from a neurochemical change in the brain as a result of the concussion

neuromd2012 :

but does not in itself suggest frank bleeding

neuromd2012 :

that is always the concern

neuromd2012 :

is there a bruise or contusion from the trauma

neuromd2012 :

as that could cause a seizure focus later on

neuromd2012 :

but that does not seem to be the case here

Customer:

I just want to make sure he does not need additional attention. No he did not have

neuromd2012 :

sure

Customer:

any bruises

neuromd2012 :

I certainly understand your concern

neuromd2012 :

right

neuromd2012 :

but he certainly had a concussion from the history

neuromd2012 :

and he should try not to have another, until his symptoms are completely gone

neuromd2012 :

as then you can get an additive or synnergistic effect

Customer:

yes, we took him to the ER because he got very dizzy and the headache he had was not going away

neuromd2012 :

right

neuromd2012 :

well that is a result of the trauma, but doesn't in itself suggest a bleed

Customer:

so it's a matter of waiting until all symtoms are gone before allowing him to go back to soccer or pe

neuromd2012 :

exactly

neuromd2012 :

really should not be out there until all of his symptoms are gone

neuromd2012 :

you look at the hockey players, it can take 4 to 6 months

neuromd2012 :

and that is the way to do it

Customer:

so it's "normal" that after 4 weeks he still have some symtoms

Customer:

wow

neuromd2012 :

because we think the changes in the brain that occur come from a synergistic response to multiple hits

neuromd2012 :

yes

neuromd2012 :

unfortunately

neuromd2012 :

most get better in a few weeks

neuromd2012 :

the criteria is if you did not have a change in level of conciousness

neuromd2012 :

then it is 2 weeks off

neuromd2012 :

but if you continue to have headaches, you are out

Customer:

as far as we know this is the first time with a concussion, but he has had hits to the head before, but never this bad

neuromd2012 :

right

neuromd2012 :

so I know this is hard to keep him out

neuromd2012 :

but you should try to limit his environment

neuromd2012 :

keep it simple

neuromd2012 :

as long as you can with the hope that his headaches go away

Customer:

at this point what level of activity would be good. Swiming?

neuromd2012 :

swimming and non-major aerobics are fine

Customer:

or nothing at all ... walking

neuromd2012 :

no contact sports

neuromd2012 :

right

neuromd2012 :

aerobics can also stimulate the vascular system in the brain too much

neuromd2012 :

and keep his headache recurring

neuromd2012 :

so gentle sports

neuromd2012 :

are fine

Customer:

ok... he is active but he feels the difference and that it's not ok yet...

neuromd2012 :

yes, he has to feel normal

Customer:

it's my husband who keeps asking what the dr says

neuromd2012 :

I see

Customer:

now I can tell him that he may not be playing soccer this spring at all

neuromd2012 :

well I am overly cautious, but those are the rules from a group of neurologists that evaluated sports injuries

neuromd2012 :

he will improve hopefully soon

neuromd2012 :

if he knows the Sidney Crosby story (pittsburgh penguin)

neuromd2012 :

he knows he is not alone

Customer:

I have no problem with being overly cautious, but really wanted to know from an expert. He sure will know this story being a Penguin fan himself.

neuromd2012 :

right

neuromd2012 :

if you want to hold on

Customer:

sure

neuromd2012 :

I can find the neurology report

neuromd2012 :

hang on

Customer:

sure

neuromd2012 :

here is a statistical summary

neuromd2012 :

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3359792/

neuromd2012 :

but I am looking for the american academy of neurology report

neuromd2012 :

hang on

Customer:

Ok.

neuromd2012 :

hi

neuromd2012 :

sorry to keep you waiting

neuromd2012 :

I cannot find it anywhere

neuromd2012 :

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3359785/

neuromd2012 :

here is a more recent article that defines guidelines for time

neuromd2012 :

he should be out

neuromd2012 :

I hope that helps when you discuss it with him

Customer:

It's ok. Dr. THANK YOU so much for answering all my questions and for giving me peace of mind.

neuromd2012 :

sure good luck

neuromd2012 :

come back if I can help

Customer:

I will read all of this information.

neuromd2012 :

Dr Frank T

neuromd2012 :

good

neuromd2012 :

bye

Customer:

:)

Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 7201
Experience: Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
Dr. Frank and 2 other Neurology Specialists are ready to help you
Expert:  Dr. Frank replied 1 year ago.
Our chat has ended, but you can still continue to ask me questions here until you are satisfied with your answer. Come back to this page to view our conversation and any other new information.

What happens now?

If you haven’t already done so, please rate your answer above. Or, you can reply to me using the box below.
Expert:  Dr. Frank replied 1 year ago.
bye
Expert:  Dr. Frank replied 1 year ago.
Hello again. I hope he is doing ok. They sent me the latest information from the American Academy of Neurology Meeting on Sports concussions in adolescents, so I will attach it here for your interest. Good Luck Dr Frank t
http://www.medscape.com/viewarticle/780973

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